Search

Anemia is a common problem in family medicine and therefore frequently investigated in general practice. Anemias are classified according to mean corpuscular volume (MCV) and reticulocyte count. An algorithm for the evaluation of the cause contains patients history and laboratory analysis including reticulocyte count, serum ferritin and CRP, serum vitamin B12, serum or erythrocyte folate and serum creatinine. Therewith most anemias in general practice can be explained. The most important types of anemia, e.g. iron deficiency anemia, are discussed as well as aspects of diagnosis and therapy. Iron deficiency anemia is often diagnosed together with other types of anemia, such as e.g. anemia of chronic disease. Particular aspects of anemia in the elderly as well as renal anemia are discussed.

In 6% of 854 patients in a city general practice anemia was found. Anemia was defined by WHO criteria. An algorithm for the evaluation of the cause includes patient's history and laboratory investigations inclusive of reticulocyte count, serum ferritin with CRP, serum vitamin B12, serum or erythrocyte folate and serum creatinine, depending on clinical situation and mean corpuscular volume (MCV). Median age of the patients was 77 years. The most frequent underlying cause of anemia was chronic renal failure (in 21%). According to the high patient's age, iron deficiency, chronic disease and malignancy were frequent for anemia, too. 35% of patients had more than one cause of anemia. The results are compared with other sparse reports from general practices and are discussed regarding the particular situation in the elderly.

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Auto-immune haemolytic anaemia (AIHA) is characterised by haemolysis associated with the presence of the immunoglobulins IgG, IgM or IgA, and/or components of the complement system on the red cell membrane. The immunoglobulins react as auto-antibodies against the red cell antigens of the patient. IgG antibodies and the complement component C3d can be detected by the direct antiglobulin test (DAT); however, IgM and particularly IgA antibodies may not necessarily be detected by the broad-spectrum anti-human-globulin serum. We present the case of a 48-yr-old woman with severe AIHA. The initial polyspecific direct antiglobulin test (DAT), using a broad-spectrum antiserum, was negative. Testing with monospecific antisera led to the diagnosis of AIHA due to warm-acting auto-antibodies solely of the IgA class, which is a very rare finding. As therapy with steroids alone did not lead to a lasting remission, splenectomy was performed 10 months after initial diagnosis. There has been no relapse of AIHA since, even after steroid medication was withdrawn and even though the monospecific IgA-DAT has remained positive. This case demonstrates the importance of performing a monospecific antiglobulin test if there is a strong suspicion of AIHA in apparently ‘Coombs-negative’ haemolytic anaemia. In AIHA caused by solely IgA antibodies, the polyspecific direct antiglobulin test may be negative or only weakly positive because of a limited content of anti-IgA antibodies in the polyspecific anti-human-globulin serum. First-line treatment of warm-type AIHA is the administration of high-dose glucocorticosteroids; splenectomy is indicated in steroid-refractory patients. [ABSTRACT FROM AUTHOR]

A 37-year-old male, splenectomized at the age of 1 year, was admitted to the ward with severe chest pain and signs of cardiogenic shock. Clinical investigations revealed the presence of both hemochromatosis and hereditary spherocytosis (HS). HLA typing showed A3,B7 and A24,B57 haplotypes and genetic analysis revealed homozygosity for the C282Y mutation. A family study was performed. The parents and four brothers were heterozygous for the C282Y mutation. Two of the brothers also presented high levels of iron stores and they had been splenectomized because of HS, while two other siblings had neither spherocytosis nor hemochromatosis. The mother had a mild anemia with dehydrated red blood cells (RBC), while the father appeared to have low-density, but normal RBC; none of them presented with spherocytosis. All siblings with spherocytosis and elevated iron stores showed a RBC density distribution similar to the mother. We present the first case with genetically proven hemochromatosis in combination with spherocytosis, focusing on the various possibilities of iron accumulation in individuals with spherocytosis and heterozygosity for the C282Y mutation. [ABSTRACT FROM AUTHOR]